When it comes to health, homeless people in their 40’s and 50’s have problems you’d usually see in people in their 70’s or 80’s.

“And those can be problems with cognition, difficulty completing tasks that younger people in general wouldn’t have trouble completing,” said Dr. Lara Johnson, who works with the Homeless Outreach Medical Services program at Parkland Memorial Hospital in Dallas. “We also see some of the chronic health conditions that seem to be at more advanced stages at younger ages, so things like lung disease, as well as diabetes and high blood pressure and cardiovascular disease.”

Johnson has treated homeless patients for nearly a decade, and she said a lot of homeless people don’t have access to health care. Many don’t have insurance, and finding a doctor and getting to a hospital is nearly impossible without a car, money or an ID.

“I think some it has to do with being in the environment — so not having a structure you can go to, not being able to get out of the sun , sleeping outside, things that are hard on your joints, not having a comfortable place to rest, not having access to good sleep, good nutrition,” she said.”

A recent study published in The Gerontologist found younger homeless people tend to struggle with things that typically older people face. That includes cognitive abilities like filling out paperwork and managing money to basic motor skills like bathing and getting dressed. Johnson said most homeless patients she sees can barely remember what diseases they have, let alone remember to take a pill regularly.

People like Samuel Patterson.

“I feel like I had gave up cause I hadn’t had my diabetic or high blood pressure medicine in six months,” he said one day at CitySquare’s Opportunity Center.

Patterson is homeless and was, until recently, living in Tent City, a homeless encampment under Interstate 45 near downtown Dallas. He’s 60 years old and has been on the streets since last fall. His diabetes was left untreated for months, and now it has caused severe nerve damage in his legs. He can’t walk or stand for too long, and he’s restricted to a wheelchair.

Not long ago, Patterson said he had a stroke alone in his tent. Now caseworkers are working on getting him the medication he needs as quickly as possible.

“If it wasn’t for that, I would’ve been gone because I could feel my inward strength pulling me down, and if I don’t do something about it after a while, all that outward strength will be gone in my arms, my legs, everything,” he said.

Patterson has a condition called diabetic neuropathy, which is not a condition unique to old age. People in their 40’s and 50’s can also develop neuropathy. But doctors say had Patterson been on medication regularly, had he had the access and the resources to treat it promptly, he could’ve avoided it.

A problem many homeless people face is storage of medications. For example, some homeless diabetics inject insulin, which should be refrigerated. That’s hard to do when you don’t have a place to live.

Then there are those who need mental health treatment. Dr. Carol North is a psychiatry professor at UT Southwestern Medical School and is the medical director of the the Altshuler Center for Education and Research at MetroCare Services, a mental health care outreach organization for the homeless.

“Mental illness in itself makes it hard to do anything sometimes, and if you have a major psychiatric illness, you may not feel like exercising or eating healthy. And you may not be able to get yourself to the doctor when you need to,” North said.

North says she sees severe mental illness in about a third of the homeless population, with illnesses like bipolar disorder and schizophrenia. She also finds nearly 80 percent of homeless people abuse drugs and alcohol. North says there just isn’t the infrastructure in place to help all those people.

“There are so many barriers, and I don’t think anybody has a really good enough handle on it to get everyone the kind of treatment that everyone deserves,” she said.

One solution has been Parkland’s clinic on wheels — a mobile RV that brings healthcare to the homeless. The clinics have been crisscrossing Dallas for more than a decade with a focus on preventive care over ER visits. But doctors and homeless advocates don’t believe they’re enough.

Cindy Crain, president of Metro Dallas Homeless Alliance, says homeless people need permanent housing in order to take care of themselves.

“There is substantial research that has identified that when you house someone first and take care of the shelter needs, now they have the hygiene needs, the kitchen, they have a bathroom, they have security and they are no longer afraid, now they can start to address other issues, different disabilities, behavioral health issues or other physical health issues,” Crain said.

It can be hard enough for people with homes to remember to take a daily vitamin. It’s a whole different story for those who constantly worry for their security with their lives on their backs.